CMS Releases OPPS Final Rule for 2011

The Centers for Medicare & Medicaid has finalized four changes to its physician supervision requirements as part of the 2011 OPPS final rule, released November 2nd.

In the final Outpatient Prospective Payment System rule, CMS:

• Changed the definition of "immediately available"
• Delayed enforcement of supervision requirements for rural and critical access hospitals (CAHs)
• Announced its plan to convene a panel beginning in 2012 to determine the level of supervision required for different services
• Finalized a new category of "nonsurgical extended duration therapeutic services" that require direct supervision during an initiation period, followed by a minimum standard of general supervision

These changes are a welcome relief and clearly show that CMS is listening to provider comments, says Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC.

"The delay for CAHs and rural hospitals, the convening of a board to review supervision levels, and the change in the definition of immediately available, are all very positive," Shah says. "Unfortunately, CMS also finalized its proposal for defining a new category of nonsurgical extended duration therapeutic services, which requires further consideration since it seems somewhat premature given that it is convening a panel to review such things and also since its delay in enforcing these rules for CAHs and rural hospitals."

Redefining immediately available

Beginning in 2011, CMS will no longer require physicians to be present in every off-campus provider-based department (PBD). Instead it will change the definition of immediately available to mean "physically present, interruptible, and able to furnish assistance and direction throughout the performance of the procedure but without reference to any particular physical boundary."